The Head and Neck 97 



was a piece of bacon rind. Morey witnessed a case where a sharp 

 piece of bone perforated both esophagus and trachea and induced 

 gangrenous pneumonia, and Cadeac saw one where a peach stone 

 perforated the aorta. 



Symptoms and Diagnosis. The symptoms of these lesions in the 

 cervical portion are painful swelling of the neck and suppuration. 

 In the thoracic portion, there are early collapse, febrile symptoms 

 and prostration. 



Treatment. When the lesion is in the cervical portion it is 

 treated by exposing the gullet as in Esophagotomy and subjecting it 

 to frequent antiseptic irrigation. Unless the rent is extensive it 

 need not be sutured. 



Stricture. Stricture sometimes results from cicatrices fol- 

 lowing wounds by foreign bodies, improper use of the probang, 

 esophagotomy, and fistula. Similar effects are produced by com- 

 pression of extrinsic neoplasms usually of the bronchial glands, ver- 

 tebral exostoses, tubercles, goiter, and verminous aneurism of the 

 aorta. , 



Symptoms and Diagnosis. Characteristic are the efforts at 

 swallowing. Liquids pass more easily than solids, which accu- 

 mulate above the stricture and distend the esophagus so that the 

 trachea and neighboring vessels and nerves are compressed results 

 tng in dyspnea, etc. 



Treatment. Stricture is treated by progressive dilation by 

 daily passage of the probang, a series of graduated instruments be- 

 ing employed. The latter are passed every two or three days and 

 left in place from five to ten minutes, each size being used three or 

 four times. 



Diverticula. A Diverticulum was observed by Schellenberg in 

 which a bite and subsequent abscess formation were the causative 

 factors. 



Treatment. Diverticula are treated by excision of a fusiform 

 portion of the stretched wall. 



FOKEIGN BODIES. 



In the esophagus, obstructions usually occur either at the proxi- 

 mal end immediately behind the pharynx, at the lower extremity of 

 the cervical portion, or at a short distance anterior to the cardiac 

 orifice where its caliber is smallest. Sharp bodies may lodge at any 



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